Fitness models provide accurate short-term forecasts of SARS-CoV-2 variant frequency.

Genomic surveillance of pathogen evolution is essential for public health response, treatment strategies, and vaccine development. In the context of SARS-COV-2, multiple models have been developed including Multinomial Logistic Regression (MLR) describing variant frequency growth as well as Fixed Growth Advantage (FGA), Growth Advantage Random Walk (GARW) and Piantham parameterizations describing variant Rt. These models provide estimates of variant fitness and can be used to forecast changes in variant frequency. We introduce a framework for evaluating real-time forecasts of variant frequencies, and apply this framework to the evolution of SARS-CoV-2 during 2022 in which multiple new viral variants emerged and rapidly spread through the population. We compare models across representative countries with different intensities of genomic surveillance. Retrospective assessment of model accuracy highlights that most models of variant frequency perform well and are able to produce reasonable forecasts. We find that the simple MLR model provides ∼0.6% median absolute error and ∼6% mean absolute error when forecasting 30 days out for countries with robust genomic surveillance. We investigate impacts of sequence quantity and quality across countries on forecast accuracy and conduct systematic downsampling to identify that 1000 sequences per week is fully sufficient for accurate short-term forecasts. We conclude that fitness models represent a useful prognostic tool for short-term evolutionary forecasting. Author summary: Over the course of the COVID-19 pandemic, SARS-CoV-2 evolved into many different genetic variants such as the well known Alpha, Beta, Gamma and Delta variants in early 2021 and the Omicron variant in late 2021. These genetic variants could more easily spread from person to person and so outcompeted previous versions of the virus. Even if they aren't being given Greek letter names, new variants are still arising with recent waves of COVID-19 caused by variants such as XBB and JN.1. Predicting which variants will increase in frequency and which variants will decrease in frequency is important for public health, particularly in terms of updating the formulation of the annual COVID-19 vaccine. In this paper, we investigate statistical models that use observed frequencies of different variants in the past weeks to estimate the frequency of different variants today and to forecast the frequency of different variants in 30 days time. We find that in countries with sufficient amounts and timeliness of genetic sequence data, that models forecast well and can be a useful tool for public health. [ABSTRACT FROM AUTHOR]